The Missouri state flag flies outside of the Planned Parenthood of the St. Louis Region and Southwest Missouri, the state's last operating abortion clinic, Friday, June 21, 2019. in St. Louis. Missouri's health department said on Friday that it won’t renew the abortion license for the state’s lone clinic, but the St. Louis Planned Parenthood affiliate will be allowed to temporarily perform the procedure under a court order. (Christian Gooden/St. Louis Post-Dispatch via AP)

Missouri rejects license renewal for lone abortion clinic

ST. LOUIS (AP) — Missouri's only abortion clinic lost its license to perform the procedure on Friday, though it remains open at least temporarily under a judge's order.

The state health department notified the Planned Parenthood clinic in St. Louis that its abortion license will not be renewed. A letter from the state cited "serious and extensive" deficiencies.

The state's decision came at the deadline set by St. Louis Circuit Judge Michael Stelzer. During a brief hearing, Stelzer said a preliminary injunction he previously issued would remain in place, meaning the clinic can continue to perform abortions at least until he issues a final ruling outlining the next steps. He offered no timetable for that ruling.

M'Evie Mead, director of Planned Parenthood Advocates in Missouri, stressed after the hearing that the bottom line is that the clinic remains open.

"You can still come to Planned Parenthood today for all of your reproductive health care, and that is a good day for women," Mead said.

The fight between the Republican-led Missouri state government and Planned Parenthood has raged since the state health department allowed the clinic's license to lapse effective June 1. Stelzer ruled earlier this month that the state needed to be more definitive and set the Friday deadline to either approve or deny the license.

The fate of the clinic has drawn national attention because Missouri would become the first state since 1974, the year after the Supreme Court's Roe v. Wade decision, without a functioning abortion clinic if it closes. The battle also comes as abortion rights supporters raise concerns that conservative-led states are attempting to end abortion through tough new laws and tighter regulation.

The state has said concerns about the clinic arose from inspections in March. Dr. Randall Williams, director of the Missouri Department of Health and Senior Services, said at a news conference in Jefferson City that Planned Parenthood corrected just four out of 30 cited deficiencies.

Mead, with Planned Parenthood, said the health department's concerns were addressed with "medically accurate and thorough responses." She said Missouri is using the licensing process as a weapon aimed at halting abortions.

Among the problems health department investigators have cited were three "failed abortions" requiring additional surgeries and another that led to life-threatening complications for the mother, The Associated Press reported this week, citing a now-sealed court filing.

Williams described a failed abortion as "a very rare complication" in which a woman has a surgical abortion but later finds out she's still pregnant.

"It's very hard to explain how that could happen," Williams said.

Missouri is among several conservative states, emboldened by new conservative justices on the Supreme Court, to pass new restrictions on abortions in the hope that the high court will eventually overturn the landmark Roe v. Wade ruling in 1973 that legalized abortion nationwide.

Republican Gov. Mike Parson signed legislation on May 24 to ban abortions at or beyond eight weeks of pregnancy, with exceptions for medical emergencies but not for rape or incest.

Parson, in a statement, said the clinic "failed to meet basic standards of care, placed multiple patients in life threatening situations, performed multiple failed abortions where patients remained pregnant, and intentionally impeded the state's health investigation by not allowing health inspectors to talk to the abortion doctors.

"If you don't comply with the law, there will be consequences," Parson said.

Rhetoric has been inflammatory from both sides. Missouri Right to Life called the St. Louis facility "the most dangerous abortion clinic in the country" and said more than 70 emergency vehicles had appeared at the clinic. The group didn't offer a time frame or data source for the statement about 70 vehicles, or provide any independent evidence for either claim.

Meanwhile, Mead described the state's requirement of a pelvic examination at the time of consultation, 72 hours before an abortion, as "state-mandated sexual assault."

The state appeared to concede on that issue. Williams said the state has determined that Planned Parenthood can defer the preliminary pelvic exam if they cite a medical reason.

The number of abortions performed in Missouri has declined every year for the past decade, reaching a low of 2,910 last year. Of those, an estimated 1,210 occurred at eight weeks or less of pregnancy, according to health department data.

In fact, more Missouri women are getting abortions in Kansas than in Missouri. Information from the state of Kansas shows that about 3,300 of the 7,000 abortions performed there last year involved Missouri residents.

Kansas has an abortion clinic in Overland Park, a Kansas City suburb just 2 miles (3 kilometers) from the state line.

The nearest clinic to St. Louis is in Granite City, Illinois, less than 10 miles (16 kilometers) away. Illinois does not track the home states of women seeking abortions so it's unknown how many Missouri residents have been treated there.